Healthcare Provider Details

I. General information

NPI: 1922345818
Provider Name (Legal Business Name): HEATHER OBRIEN COTA/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 01/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 E MAIN ST
WEST BROOKFIELD MA
01585-2906
US

IV. Provider business mailing address

47 E MAIN ST
WEST BROOKFIELD MA
01585-2906
US

V. Phone/Fax

Practice location:
  • Phone: 508-867-7716
  • Fax:
Mailing address:
  • Phone: 508-867-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number3035
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: